Reply to “Statins may decrease the Fatality Rate of MERS Infection”

Totura, Allison L.; Baric, Ralph S.

S ince the emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) on the Arabian Peninsula in 2012, there has been a steady stream of MERS cases geographically focused in the Middle East, indicating that either zoonotic transmission from camel to human or person-to-person transmission likely takes place on a frequent basis (1) . As reaffirmed by the recent MERS outbreak in South Korea, highly pathogenic coronaviruses are capable of causing epidemics affecting hundreds of individuals as a result of sustained person-to-person transmission in nosocomial settings that can be linked to a single traveler who became an index patient (2) . Currently, the best public health strategy to circumvent sustained coronavirus transmission in an outbreak situation is to quarantine individuals who have a history of contact with confirmed cases of MERS. In the most recent outbreak in South Korea, this led to the isolation and monitoring of more than 16,000 individuals, a feat that may not be economically or logistically feasible in future outbreaks (2) . Due to the diversity and presence of prepandemic zoonotic coronaviruses in bat populations, we may expect the continual reemergence of highly pathogenic coronaviruses related to MERS-CoV, SARS-CoV (severe acute respiratory syndrome coronavirus), or other CoV strains to be a future risk to global public health (3, 4) . There is clearly a need for coronavirus-specific medical countermeasure strategies against these respiratory pathogens, as studies indicate that general antiviral medications like interferon and ribavirin are ineffective in MERS or SARS patients (5, 6) .